Prognosis Factors of the Co-Presentation of ARDS and Sepsis: A Systematic Review

Abstract

Background: The co-occurrence of acute respiratory distress syndrome (ARDS) and sepsis presents a critical challenge in critical care medicine. ARDS involves diffuse alveolar damage, leading to severe hypoxemia, while sepsis entails a dysregulated host response to infection, resulting in systemic inflammation and organ dysfunction. This study aims to provide a comprehensive understanding of the contributing factors to ARDS and sepsis co-presentation, highlighting its significance in clinical scenarios, often leading to severe respiratory compromise and increased mortality risk. The findings offer original insights into potential biomarkers and therapeutic strategies that could inform future research and clinical practices. Methods: This systematic review adheres to PRISMA 2020 guidelines. Inclusion criteria cover studies on ARDS and sepsis co-presentation (2014–2024), diverse designs, human participants, and English articles. Electronic searches (PubMed, Embase, Cochrane Library) utilized MeSH terms and free-text. Manual searches ensured comprehensive exploration. Two reviewers screened titles/abstracts and conducted full-text eligibility assessments. Data extraction involved a narrative synthesis, focusing on study outcomes, strengths, and limitations. Results were organized into tables for clarity. Results: Of 1624 studies, 343 duplicates were removed. 1281 studies underwent title/abstract screening, with 149 assessed for eligibility. 138 studies were excluded, yielding 11 included studies. These studies, involving 4086 patients, utilized diverse methodologies. Mortality risk, molecular phenotypes, immune responses, potential biomarkers, and fluid management strategies were identified. Limitations included study heterogeneity and biases. Conclusion: This systematic review provides nuanced insights into ARDS and sepsis co-presentation. The originality of this review lies in its identification of novel biomarkers and therapeutic avenues, which may contribute to refining clinical approaches and informing future research. Despite valuable findings, limitations exist in study methodologies and challenges in establishing causality. The review underscores the need for ongoing updates and emphasizes the importance of prospective, multicenter studies with standardized methodologies for robust evidence and improved clinical practices.